المؤلفون: Schwieters, Kurt, Voigt, Richard, McDonald, Suzette, Scanlan-Hanson, Lori, Norman, Breanna, Larson, Erin, Garcia, Alexis, Madsen, Bo, Rudis, Maria, Bellolio, Fernanda, Hevesi, Sara

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health.

مصطلحات موضوعية: Medication Reconciliation, Emergency Medicine, PDSA cycles, Quality Improvement

الوصف: Introduction: Patients who stay in the emergency department (ED) for prolonged periods of time require verification of home medications, a process known as medication reconciliation. The complex nature of medication reconciliation can lead to adverse events and staff dissatisfaction. A multidisciplinary team was formed to improve accuracy, timing, and staff satisfaction with the medication reconciliation process.Methods: Between November 2021–January 2022, stakeholders were surveyed to identify gaps in the medication reconciliation process. This project implemented education on role-specific tasks, as well as a “Let’s chat!” huddle, bringing together the entire care team to perform medication reconciliation. We used real-time evaluations by frontline staff to evaluate effectiveness during plan- do-study-act cycles and obtain feedback. Following the implementation period, stakeholders completed the post-intervention survey between June-July 2022, using a 4-point Likert scale (0 = very dissatisfied to 3 = very satisfied). We calculated the change in staff satisfaction from pre-intervention to post-intervention. Differences in proportions and 95% confidence intervals are reported. This study adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) and followed the Lean Six Sigma rapid cycle process improvement (define-measure-analyze-improve-control).Results: A total of 111 front-line ED staff (physicians, nurse practitioners, physician assistants, pharmacists, nurses) completed the pre-intervention survey (of 350 ED staff, corresponding to a 31.7%response rate), and 89 stakeholders completed the post-intervention survey (a 25.4% response rate). Subjective feedback from staff identifying causes of low satisfaction with the initial process included the following: complexity of process; unclear delineation of staff roles; time burden to completion; high patient volume; and lack of standardized communication of task completion. Overall satisfaction improved after the intervention. The greatest improvement was seen in the correct medication (difference 20.7%, confidence interval [CI] 6.3–33.9%, P < 0.01), correct dose (25.6%, CI 11.4–38.6%, P < 0.001) and time last taken (24.5%, CI 11.4–37.0%, P < 0.001).Conclusion: There is a steep learning curve to educate multidisciplinary staff on a new process and implement the associated changes. With goals to impact the safety of our patients and reduce negative outcomes, engagement and awareness of the team involved in the medication reconciliation process is critical to improve staff satisfaction.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3784k0tjTest

المؤلفون: Mandu, Rogers, Miller, Lara, Namazzi, Gertrude, Twum-Danso, Nana, Achola, Kevin, Cooney, Isabella, Santos, Nicole, Masavah, Leakey, Nyakech, Alphonce, Kirumbi, Leah, Waiswa, Peter, Walker, Dilys, Butrick, Elizabeth

المصدر: BMJ Open Quality. 12(4)

مصطلحات موضوعية: Health services research, Implementation science, Maternal Health Services, PDSA, Paediatrics, Humans, Infant, Newborn, Female, Pregnancy, Child, Quality Improvement, Premature Birth, Kangaroo-Mother Care Method, Africa, Eastern, Clinical Competence

الوصف: BACKGROUND: Quality improvement collaboratives (QIC) are an approach to accelerate the spread and impact of evidence-based interventions across health facilities, which are found to be particularly successful when combined with other interventions such as clinical skills training. We implemented a QIC as part of a quality improvement intervention package designed to improve newborn survival in Kenya and Uganda. We use a multi-method approach to describe how a QIC was used as part of an overall improvement effort and describe specific changes measured and participant perceptions of the QIC. METHODS: We examined QIC-aggregated run charts on three shared indicators related to uptake of evidence-based practices over time and conducted key informant interviews to understand participants perceptions of quality improvement practice. Run charts were evaluated for change from baseline medians. Interviews were analysed using framework analysis. RESULTS: Run charts for all indicators reflected an increase in evidence-based practices across both countries. In Uganda, pre-QIC median gestational age (GA) recording of 44% improved to 86%, while Kangaroo Mother Care (KMC) initiation went from 51% to 96% and appropriate antenatal corticosteroid (ACS) use increased from 17% to 74%. In Kenya, these indicators went from 82% to 96%, 4% to 74% and 4% to 57%, respectively. Qualitative results indicate that participants appreciated the experience of working with data, and the friendly competition of the QIC was motivating. The participants reported integration of the QIC with other interventions of the package as a benefit. CONCLUSIONS: In a QIC that demonstrated increased evidence-based practices, QIC participants point to data use, friendly competition and package integration as the drivers of success, despite challenges common to these settings such as health worker and resource shortages. TRIAL REGISTRATION NUMBER: NCT03112018.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5547x14fTest

المؤلفون: Valerie N. Holt, Elan Pelegrí, Mary Hardy, Lindsey Buchin, Isaac Dapkins, Meleen Chuang

المصدر: BMC Pregnancy and Childbirth, Vol 24, Iss 1, Pp 1-13 (2024)

مصطلحات موضوعية: Initiation of care, First trimester prenatal care, Barriers to prenatal care, Federally qualified health center, Process improvement, PDSA, Gynecology and obstetrics, RG1-991

الوصف: Abstract Background Early initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient’s ability to receive necessary care. Aim This study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives. Methods An initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry. Results The age of patients in the population of interest (n = 169) was bimodal, with a range of 15 – 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age. Conclusion Our study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2393Test

الوصول الحر: https://doaj.org/article/6dcfa4e5cfcc4fe4a56a98a4ff307e06Test

المؤلفون: Singh, Charleen, Shoqirat, Noordeen, Thorpe, Lee, Villaneuva, Stephanie

المصدر: BMJ open quality. 12(2)

مصطلحات موضوعية: Humans, Prospective Studies, Leadership, Pressure Ulcer, PDSA, continuous quality improvement, leadership, nurses, quality improvement, Prevention, Physical Injury - Accidents and Adverse Effects, Clinical Research, Injuries and accidents

الوصف: The quality department used adaptive leadership and the plan-do-study-act cycle to decrease pressure injury (PI) rates. After identifying gaps, the pressure injury prevention bundle was developed and implemented to bring evidence-based nursing practice to frontline nurses. Organisational rates of PI was followed for 4 years (2019-2022) and a smaller subset of 88 patients were followed in the prospective arm. Using statistical analysis, the decrease in PI rates (90%) and severity is significant (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0m9813dvTest

المؤلفون: Stine Bjerrum Moeller, Lotte Kring

المصدر: Frontiers in Psychology, Vol 15 (2024)

مصطلحات موضوعية: technology in healthcare systems, PROM (patient-reported outcome measures), plan-do-study-act (PDSA), training program, thematic analysis (TA), focus group interviews, Psychology, BF1-990

الوصف: This study explores the integration of a web-based electronic database technology containing patient-reported outcome measures (PROMs) with electronic health records for refugees with PTSD, emphasizing the systematic inclusion of patient perspectives in clinical decision-making. Our research addresses the notable gap in literature regarding training clinicians for the competent integration of health information technology in healthcare. The training program developed aimed at equipping clinicians, particularly inexperienced with technology, to effectively utilize an electronic PROM system for collecting systematic patient information. Our study is set in the context of the Mental Health Services (MHS) in Denmark, focusing on a specialized clinic for treating trauma-affected refugees. The multidisciplinary team involved in this project reflects a wide range of healthcare professionals. The training program employed a variety of activities over nearly 2 years, adapting to feedback and aiming to engage clinicians in continuous improvement processes. Analyzing qualitative data with thematic analysis we interpreted that the training’s extended focus on discussion of the implementation process, with limited hands-on experience, potentially reinforced clinicians’ hesitations toward new technology, rather than reducing them. Clinicians prioritized immediate concerns over potential long-term benefits. Despite this, their approach reflects a strong commitment to patient welfare and careful evaluation of new practices. Notably, there were also positive engagements with the technology, highlighting its potential in patient care. This study concludes that the successful integration of technology in clinical settings hinges on its alignment with clinicians’ workflows, respect for their professional judgment, and clear benefits to patient care.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1355588/fullTest; https://doaj.org/toc/1664-1078Test

الوصول الحر: https://doaj.org/article/520503002c494134814756c93f02999bTest

المؤلفون: Meshel, Alexander, Iavicoli, Laura, Dilos, Barbara, Agriantonis, George, Kessler, Stuart, Fairweather, Phillip, Nazarian, Devorah, Lugassy, Daniel, Bentley, Suzanne

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 24(1)

مصطلحات موضوعية: Educational Innovation, PDSA Ramp, Simulation, Trauma, Medical Education

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/24t913kkTest

المؤلفون: ZHOU Xuan, ZHANG Dan

المصدر: Zhongguo quanke yixue, Vol 27, Iss 02, Pp 192-200 (2024)

مصطلحات موضوعية: multimorbidity, multiple chronic health conditions, aged, integrated care model, pdsa, medical combination, self-management, case management, Medicine

الوصف: The continuous increase in the prevalence of comorbidities has severe challenges to population health management, and the World Health Organization (WHO) recommends the development of integrated medical care models to cope with the pressure of health management of patients with comorbidities. In this paper, we constructed an integrated management model for geriatric comorbidities under medical association based on PDSA theory, in order to continuously improve the management ability and effect in the reciprocal cycle of "plan-execute-research-act". The model consists of four key elements, including management team, management process, management tools and management effect. Based on previous intervention research, the model integrates patient-centered care, multidisciplinary team, patient self-management and other intervention methods, and relies on big data technology to establish a decision support platform, thus realizing the whole life cycle health management of patients with comorbidities.

وصف الملف: electronic resource

العلاقة: https://www.chinagp.net/fileup/1007-9572/PDF/20230374.pdfTest; https://doaj.org/toc/1007-9572Test

الوصول الحر: https://doaj.org/article/83852061646c4470821ff2c4ca0ca9acTest

المؤلفون: Gedefa Bayisa, Kebena Limenu, Nemomsa Dugasa, Bikila Regassa, Muhamedamin Tafese, Mulugeta Abebe, Indalkachew Shifera, Diriba Fayisa, Habtamu Deressa, Asefa Negari, Amsalu Takele, Temesgen Tilahun

المصدر: BMC Research Notes, Vol 17, Iss 1, Pp 1-7 (2024)

مصطلحات موضوعية: Pain-free hospital, PDSA cycle, Wallaga, Ethiopia, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390

الوصف: Abstract Objective This quality improvement project is aimed to increase pain free hospital implementation from 21.7 to 80% at Wallaga University Referral Hospital (WURH) from January 1, 2023 to June 30, 2023. Methods Hospital based interventional study was conducted at WURH. The Plan- Do-Study-Act (PDSA) cycle was used to test change ideas. A fishbone diagram and a driver diagram were used to identify root causes and address them. Major interventions included training of health professionals, initiation of pain as fifth vital sign, policy and protocol development, and conducting regular supportive supervision. Results Upon completion of the project, overall pain-free hospital implementation increased from baseline 21.7–88.7%. Implementation of pain as 5th the vital sign was increased from 15.4 to 92.3%. Regular audits of pain assessment and management increased from 27.3 to 81.8%. Two standardized treatment protocols or chronic and acute pains were developed from baseline zero. A focal person for Pain-free hospital implementation was assigned. More than 85% of healthcare providers were trained in pain assessment and management. Conclusion Compliance with pain-free hospital implementations was significantly improved in the study area. This was achieved through the application of multidimensional change ideas related to health professionals, standardized guidelines and protocols, supplies, and leadership. Therefore, we recommend providing regular technical updates & conducting a frequent clinical audit on pain management.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1756-0500Test

الوصول الحر: https://doaj.org/article/e5549a1cd6e844219eff5636f96aab02Test

المؤلفون: Mohsen Alzahrani, Mohammad Alkaiyat, Mona Alshami, Thamer Alotaibi, Sultan Meashi, Elham Al Enizi, Hussam Shehata, Ammar Khaleel, Anas Abu Esbaa, Reem Al Harbi, Mohamad Alharbi

المصدر: Global Journal on Quality and Safety in Healthcare, Vol 6, Iss 3, Pp 81-88 (2023)

مصطلحات موضوعية: chemotherapy, quality, resource utilization, medication, pdsa, Medicine (General), R5-920

الوصف: Introduction The outpatient oncology infusion unit is very busy, serving 60 to 70 patients per day. Due to a limited number of nurses, treatment chairs, only one pharmacy hood for bio-hazardous drug preparation, and other factors, patients wait a long time before starting their treatment, which affects the patient experience negatively. We conducted a quality improvement project to reduce the waiting time before starting the treatment, improve the patients' experience, and allow the unit to work more effectively through better resource utilization and accommodating more patients. Methods A committee was formed with representatives from oncology nursing and the quality specialist, chemotherapy pharmacy supervisor, data manager, and a medical consultant (team leader). We studied baseline data of patient waiting times from January to March 2019 and the factors that contributed to delays before starting the treatment. The charge nurse identified patients who could safely have their medication released early in the morning at 7 am, enabling the pharmacy to dispense at 8 am without their actual presence being required in the infusion suite (i.e., medication early release program or MERP). Multiple plan-do-study-act (PDSA) cycles were implemented to achieve a wait time from check-in to medication administration of less than 60 minutes. Data collected included check-in time, chair time, vital signs time, administration time, and discharge time. Additionally, reasons for drug wastage were assessed for patients who did not receive the prepared medication. A patient satisfaction survey was conducted with the patients before and after being enrolled in the program. Results At baseline, average waiting time for patients receiving similar medications in the MERP was 2 hours and 27 minutes. After the first intervention, average waiting time was reduced to 1 hour and 24 minutes, and small improvements were observed after each PDSA cycl. A major breakthrough occurred after an intensive patient education program and enforcement of strict compliance with the criteria in selecting the patients appropriate for theMERP. Average waiting time wasreduced to ≤ 60 minutes, and in November 2022, it was 30 minutes on average. Drug wastage was identified as a balancing measure. We were successful in reducing drug wastage by implementing several changes and patient education measures and achieved zero wastage. The patient satisfaction survey showed better satisfaction with the new changes. Conclusion A positive impact was achieved in this quality improvement project, with a significant reduction in the average waiting time for patients to start receiving chemotherapy. The outcome of this project has been maintained for 4 years and is still ongoing.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2589-9449Test

الوصول الحر: https://doaj.org/article/af38ffe15a1c4ea48dca2eae527315b3Test

المؤلفون: Pulak Kalita, Pranay Dey, Sweety Begum

المصدر: New Indian Journal of OBGYN, Vol 10, Iss 1, Pp 142-148 (2023)

مصطلحات موضوعية: plan-do-study-act (pdsa) cycle, fish bone analysis, neonatal survival, early breast feeding in caesarean section, early initiation of breast feeding, Gynecology and obstetrics, RG1-991

الوصف: Objective: To improve the rate of breast feeding within first hour of caesarean delivery over a period of 3 months through quality improvement process. Methods: Baseline rate of breast feeding within first hourof caesarean delivery was measured.Fish bone analysis and Process flow mapping was done to elicit the possible reasons for delay in initiating breast feeding. A series of Plan-Do-Study-Act (PDSA) Cycle was conducted to test change ideas brought forth by forming a team of paediatrician, obstetrician and nurse. Result: The rate of first-hour initiation of breastfeeding increased from 0% to 82% over the study period. The average time at of breastfeeding at the end of PDSA4 was found to be 52 minutes. The results were sustained after the last PDSA cycle. Conclusion: A quality improvement study focussing on health promotion, appropriate intervention and nursing staff’s support in providing early skin to skin contact with initiation of breast feeding for patients undergoing caesarean section, was able to accomplish sustained improvement in breastfeeding rates within 1st hour of caesarean deliveries.

وصف الملف: electronic resource

العلاقة: http://journal.barpetaogs.co.in/pdf/010142.pdfTest; https://doaj.org/toc/2454-2334Test; https://doaj.org/toc/2454-2342Test

الوصول الحر: https://doaj.org/article/3249ceed42bb4f309ea3c0f1835a6c5bTest